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Flashcards in General cardiac Deck (63):
1

what is aortic coarctation? What are some physical signs you would look for if a patient had aortic coarctation?

Narrowing of the aortic arch distal to the left subclavian artery. Congenital cause. Some physical signs include: radio femoral delay, increased blood pressure, scapular bruit, systolic murmur over the scapula (L)

2

what can a radio femoral delay indicate?

aortic coarctation or aortic dissection

3

What does the TIMI score indicate?

For NSTEACs it calculates the risk
1. Age > 65 years
2. Greater than 3 CAD risk factors
3. Stenosis > 50%
4. Aspirin use in the past 7 days
5. 2 episodes of angina in last 2 days
6. ECG ST changes > 0.5 mm
7.Troponin rise.

4

What branches come off the left circumflex artery?

Obtuse marginal branches

5

what branches come off the right coronary artery?

acute marginal branches

6

what branches come off the left anterior descending artery?

diagonal branches

7

what branches come off the left anterior descending artery?

diagonal branches

8

what are some complications of a myocardial infarct?

Rupture--> tamponade, MR due to papillary muscle rupture, arrhythmias like VT and heart block, acute heart failure --> APO, pericarditis and reinfarction with another plaque.

9

What 6 clinical features do we see in a ruptured AA aneurysm?

1. Collapse
2. Sudden onset of abdominal pain
3. Look for a pulsatile mass in abdominal
4. Features of progressive hypovolemia
5. HR may not be a feature in older people bc of beta blockers etc.
6.Some people may become unconscious/obtundant.

10

what is an aneurysm?

• Focal dilatation of the artery
• 1.25 greater diameter than adjacent normal artery
-Weakness in elastin and collagen in the adventitia and media.

11

what do you see in proximal inflow aorto/iliac lower limb occlusive disease?

(claudication in the calf,+ thigh + buttock. You would expect the femoral pulse to be reduced or absent and there might be a bruit over the aorta/iliac)

12

what clinical features would you see in femoral/popliteal lower limb occlusive disease?

(claudication in the calf. Reasonable femoral pulse, weak or absent popliteal and pedal pulse. Bruit may be heard over the femoral or popliteal arteries.

13

What clinical features would you see in talo-crural lower limb occlusive disease?

(no claudication. Popliteal and pedal pulses may be reduced. Gangrene in foot may be present. Rest pain may be a feature. Popliteal bruit may be present)

14

what is the clinical diagnosis of claudication? where do you mostly see it?

Clinical diagnosis- calf pain on exertion +/- thigh; +/- buttock. Onset and severity is related to workload. It is relieved by rest and is reproducible. mostly seen in posterior calves

15

What is the WHO definition of MI

1. Symptoms of myocardial ischaemia (SOB, chest pain etc)
2. Elevation of cardiac markers (troponin or CK)
3. Typical electrocardiographic pattern involving the development of Q waves, ST segment changes or T wave changes

16

what is the usual post hospital management of a MI?

• Modify cardiac risk factors (diabetes, cholesterol levels, hypertension)
• Medication compliance
• Modify lifestyle
• Follow up- review at 1 month, then 6 months thereafter. Repeat echo at 6 months
Stress testing at 1 year

17

what are some procedural ways we can manage AF?

-Electrical cardioversion
-AV node ablation and pacemaker insertion
-Radiofrequency catheter ablation of arrhythmogenic foci in atria, usually found around pulmonary veins
-Surgical maze procedure
-Internal atrial defibrillators
-Obliteration of left atrial appendage.

18

what are the 3 types of cardiomyopathy? what kind of pathologies do they cause?

1.hypertrophic, 2. restrictive, 3. dilated
Hypertrophic/restrictive= poor diastolic function
dilated= poor systolic function

19

what are some causes of dilated cardiomyopathy?

toxins like alcohol, myocarditis, post partum, genetic inheritance of mutated muscle proteins like titin, pheochromocytoma, and haemachromatosis

20

what bacteria is associated with rheumatic heart fever?

strep pyogenes

21

what causes new onset AF?

• Pneumonia
• Ischaemic heart disease (ACS)
• Rheumatic heart disease/ valvular disease
• Anaemia
• Thyroid disease
• Electrolyte disorders
• Sepsis
Think PIRATES

22

what is the significance of type A vs Type B aortic dissection?

Type A- consider for surgery whereas type B- medical management

23

what is Dressler's syndrome?

Pericarditis as a complication of myocardial infarction. Symptoms are fever, pleuritic chest pain, pericarditis and pericardial effusion
Pathophys: autoantibodies against the heart muscle

24

what valvular disease would you expect to cause displacement of the apex?

Aortic regurgitation, mitral regurgitation

25

What are the 4 parts to a tetralogy of Fallot congenital heart disease?

1. VSD (ventricular septal defect)
2. Right ventricular hypertrophy
3. Pulmonary artery stenosis
4. Overriding aorta

26

what are the 3 criteria for STEMI?

3 criteria for STEMI:
1. ST elevation > than 2 mm in V1-V6
2. ST elevation > 1mm in the limb leads
3. New LBBB
(any one of these= STEMI)

27

which leads do we look for an anterolateral infarct?

LCx artery- V5, V6, I and aVL

28

which leads on ECG do we look for an anteroseptal infarct?

LAD artery- V1-V4

29

which leads on ECG do we look for an inferior infarct?

RCA artery- II, III, aVF

30

what are the 5 steps for reading an ECG?

1. Rate and rhythm
2. Axis
3. QRS (+ BBB)
4. ST
5. QT intervals

31

what is prinzmetal angina, and how does it differ from typical angina?

Prinzmetal angina is caused by vasospasm of the coronary arteries as compared to an atherosclerotic plaque. Generally distinguished by exercise stress test- prinzmetal angina is exercise tolerant.

32

what murmurs decrease/increase with valsalva manoeuvre?

All murmurs decrease except for HOCM systolic murmur which increases with valsalva manoeuvre

33

what do you think if you see global low voltage ECG?

Cardiomyopathy or a pericardial effusion

34

What is pericarditis? how do we normally manage this?

Inflammation of the pericardial tissue. Pericardiocentesis if tamponade on the heart, or medical management- NSAID, colchicine, PPI

35

when do you get a parasternal heave during cardiovascular examination?

right ventricular hypertrophy or cor pulmonale

36

what constitutes Unstable Angina?

• New onset angina
• Angina becoming more frequent and severe
• Angina at rest >20mins
-Post MI angina

37

what does hypertension do to the MAP graph?

shifts to the right

38

tell me the pathophysiology of CCF? (refer to frank starling mechanism)

• As CO drops due to heart failure, the body must compensate to increase End diastolic pressure as defined by the Frank Starling Curve.
• If EDV is increased, then the heart will contract harder and increase CO
• The baroreceptor reflex detects the drop in CO and this leads to sympathetic activation of Renin angiotensin system that increases vasoconstriction and fluid retention via aldosterone secretion.
Overtime the heart decompensates and fluid retention becomes third spacing, manifesting as oedema in the ankle and signs of fluid overload.

39

what are some precipitants of heart failure?

• Ischaemic heart disease
• Valvular heart disease
• Hypertensive heart disease
• Congenital heart disease
• Cardiomyopathy
• Cor pulmonale
Pericardial disease

40

which valve is associated with IVDU infective endocarditis?

tricuspid valve usually

41

what clinical signs indicate sustained hypertension?

FUNDOSCOPY!!
Hypertensive retinopathy - AV nipping
Silver wiring

42

fever + murmur?

is infective endocarditis unless proven otherwise

43

what is kussmaul's sign relating to the JVP

JVP rises with inspiration= kussmaul's sign. This indicates constrictive pericarditis

44

what does a S4 heart sound indicate? when does it occur?

turbulence during stiff atrial contraction- occurs before S1

-associated with AS or HOCM

45

what does a S3 heart sound indicate?

turbulence during early filling of ventricle.

-associated with aortic regurgitation or mitral regurgitation

46

what are the 5 manoeuvres which can affect the intensity of heart murmurs?

1. Inspiration/Expiration (Left vs Right sided)
2. Deep expiration, lean forward (AR)
3. Valsalva (HCM)
4. Standing to squatting
5. Isometric exercise

47

name the 3 types of pan systolic murmurs?

Mitral regurgitation
Ventral septal defect
Tricuspid regurgitation

48

what type of murmur is atrial septal defect?

mid systolic murmur

49

what causes a late systolic murmur?

mitral valve prolapse

50

what type of murmur is a patent ductus arteriosus?

continuous murmur

51

what do we mean by a flow murmur?

an innocent murmur often due to anaemia or thyrotoxicosis

52

what do you think when you have a quadruple heart sound murmur?

severe ventricular dysfunction

53

pathogen associated with rheumatic fever?

group A strep- strep pyogenes

54

what are some other features of rheumatic fever besides the murmur?

arthritis
rash erythema marginatum
subcutaneous nodules over elbows
sydnenham's chorea

55

what sort of HS reaction is rheumatic fever?

type 2 (antibody cross reactivity)

56

where do we find rheumatic fever?

northern territory

57

how do we calculate ejection fraction?

SV/EDV

58

what are some clinical features of AS?

SOB and chest pain on exertion
syncope

slow upstroke pulse
ejection systolic murmur on R sternal edge
radiates to carotids

59

is the apex beat displaced in AS?

not usually. causes concentric hypertrophy

60

what are some causes of aortic regurgitation?

aortic valve damage due to endocarditis
aortic valve dilation due to marfans

61

when do we begin surgery for aortic regurgitation?

BEFORE symptoms
Echo criteria of LVH and LV dysfunction is the main indication for surgical intervention

62

some causes of MR?

post MI
myxomatous mitral valve degeneration
infective endocarditis
rheumatic fever

63

what are some causes of TR?

IV drug use endocarditis
right heart failure and pulmonary HT